Housing Application — Green Haven Management

Personal Information

Tell us who this application is for. Everything you share stays confidential with our team.

Full name * Date of birth *

Current address *

Phone number * Email address *

Emergency contact — name & phone * Agency / caseworker — only if applying on someone's behalf (name, organization & contact)

Health & Lifestyle

These answers help us match you with the right home and housemates. They're kept private and never shared without your consent.

Do you have any mobility limitations? *

Yes No

Please tell us more

Any dietary restrictions or special needs? *

Yes No

Please tell us more

Do you take daily medications? *

Yes No

Anything we should be aware of? (optional)

Any chronic medical conditions or disabilities? *

Yes No

Please tell us more

Independent Living Needs

Green Haven homes are independent shared living — this helps us make sure it's the right fit.

Do you require assistance with daily tasks? *

Yes No

What kind of assistance?

How long do you expect to stay? *

Short-term Long-term Not sure yet

Do you have a bank account for automatic payments? *

Yes No

Compatibility & Preferences

A few words in your own voice — this is how we match housemates well.

Describe your daily routine or lifestyle * What's important to you in a home environment? * How do you handle conflict or disagreements in shared spaces?

Are you willing to live peacefully in a shared living environment? *

Yes No

Goals & Expectations

Where are you headed? We'd love to help you get there.

What are your goals while living in this home? * What do you hope to get out of your stay here?

Do you have a verifiable monthly income? *

Yes No

Source of income (employment, benefits, agency support, etc.)

Consent & Acknowledgment

Almost done — please review and sign below.

Signature — type your full legal name * Date *

Thank you — one last step.

Your email app should have opened with your application ready to send to info@greenhavenmanagement.com. If it didn't, copy your application below and email or text it to us — we respond within one business day.

Open Email Again

Questions? Call or text +1 (220) 223-6060

Start your new chapter.

Personal Information

Health & Lifestyle

Independent Living Needs

Compatibility & Preferences

Goals & Expectations

Consent & Acknowledgment

Thank you — one last step.